A De Novo Tool to Measure the Preclinical Learning Climate of Medical Faculties in Turkey Nilufer Demiral Yilmaza Ozlem Coskunf Ege University Gazi University
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ISSN 1303-0485 • eISSN 2148-7561 DOI 10.12738/estp.2016.1.0064 Received | April 29, 2015 Copyright © 2015 EDAM • http://www.estp.com.tr Accepted | September 9, 2015 Educational Sciences: Theory & Practice • 2015 December • 15(6) • 1503-1515 OnlineFirst | October 5, 2015 A De Novo Tool to Measure the Preclinical Learning Climate of Medical Faculties in Turkey Nilufer Demiral Yilmaza Ozlem Coskunf Ege University Gazi University Serpil Velipasaoglub Isıl Irem Budakoglug Dokuz Eylül University Gazi University Hatice Sahinc Sumer Mamaklih Ege University Akdeniz University Bilge Uzun Basustad Funda Ifakat Tengizi Hacettepe University Izmir University of Economics Ozlem Midike Halil Ibrahim Durakj Ondokuz Mayis University Ege University Sema Ozank Dokuz Eylül University Abstract Although several scales are used to measure general and clinical learning climates, there are no scales that assess the preclinical learning climate. Therefore, the purpose of this study was to develop an effective measurement tool in order to assess the preclinical learning climate. In this cross-sectional study, data were collected from 3,540 preclinical medical students of six medical faculties in Turkey. The methodology included the following activities: generate an item pool, receive expert opinions, perform a pretest to purify the instrument, and conduct factor and reliability analyses. According to the factor analysis, eight factors were determined and their contribution to the variance was 50.39%. In addition, the item factor loadings ranged from .31 to .91, Cronbach’s alpha coefficients for the subscales ranged from .72 to .77, and the item-total correlation coefficients for the subscales ranged from .44 to .76. All the items significantly discriminated between the low- and high-performing students (t = 99.57; p = .01). The scale included 52 items with the following subscales: management, teaching, teaching staff, institutional commitment, emotions, inter-student relationships, physical environment, and motivation. The analysis of this newly developed Preclinical Learning Climate Scale (PLCS) indicated that its psychometric properties are appropriate and this scale can be employed to evaluate medical education programs. Keywords: Education • Medical • Undergraduate • Learning climate • Psychometrics Educational Sciences: Theory & Practice Learning climates are important as they directly et al., 2011; Roff & McAleer, 2001). In this regard, influence the learners’ work within them (and the curriculum’s structure and its management, the vice versa) and provide a measure to determine educational-social activities offered to the students, the effectiveness of such climates in educational and the school’s relationship with the environment institutions (Dornan, Mann, Scherpbier, Spencer, & all shape the school’s learning climate (Demiral Norman, 2011). This topic has been one of the main Yilmaz, 2010; Roff & McAleer, 2001). Thus, by subjects of focus in previous evaluations of medical measuring the learning climate, an educational education programs (Kennedy, Lilley, Kiss, Littvays, program can be evaluated to identify its positive & Harden, 2013; Soemantri, Herrera, & Riquelme, and negative aspects (based on the opinions of 2010; WFME Standards, 2003). Learning climate teaching staff and students), following which inter- has been defined as the quality of the learning institutional comparisons can be performed and environment as perceived by teaching staff and overall improvements can be achieved (Dornan et students (Genn, 2001). When students attend a al., 2011). new educational institution, they not only become An examination of recent medical educational acquainted with the curriculum but also become environment instruments reveals that there are aware of the learning climate when they take exams, many differences between educational institutions. attend classes, or participate in activities (Dornan These differences are in part attributable to the fact a Corresponding author Nilufer Demiral Yilmaz (PhD), Department of Medical Education, Faculty of Medicine, Ege University, Bornova, Izmir 35100 Turkey Research areas: Medical education; Education administration; Vocational skills training; Assessment and evaluation; Psychometrics Email: [email protected] b Asst. Prof. Serpil Velipasaoglu (MD, PhD), Department of Medical Education, Faculty of Medicine, Dokuz Eylül University, İnciralti, Izmir 35340 Turkey Email: [email protected] c Assoc. Prof. Hatice Sahin (MD, PhD), Department of Medical Education, Faculty of Medicine, Ege University, Bornova, Izmir 35100 Turkey Email: [email protected] d Bilge Uzun Basusta (PhD), Department of Medical Education and Informatics, Faculty of Medicine, Hacettepe University, Sihhiye, Ankara 06100 Turkey Email: [email protected] e Ozlem Midik (MD, PhD), Department of Medical Education, Faculty of Medicine, Ondokuz Mayis University, Atakum, Samsun 55280 Turkey Email: [email protected] f Ozlem Coskun (MD, PhD), Department of Medical Education, Faculty of Medicine, Gazi University, Yenimahalle, Ankara 06560 Turkey Email: [email protected] g Prof. Işil Irem Budakoglu (MD, PhD), Department of Medical Education, Faculty of Medicine, Gazi University, Yenimahalle, Ankara 06560 Turkey Email: [email protected] h Sumer Mamakli (MD, PhD), Department of Medical Education, Faculty of Medicine, Akdeniz University, Kampus, Antalya 07070 Turkey Email: [email protected] i Funda Ifakat Tengiz (MD, PhD), Vocational School of Health Services, Izmir University of Economics, Balçova, Izmir 35330 Turkey Email: [email protected] j Prof. Halil Ibrahim Durak (MD, PhD), Department of Medical Education, Faculty of Medicine, Ege University, Bornova, Izmir 35100 Turkey Email: [email protected] k Assoc. Prof. Sema Ozan (MD, PhD), Department of Medical Education, Faculty of Medicine, Dokuz Eylül University, İnciralti, Izmir 35340 Turkey Email: [email protected] 1504 Demiral Yilmaz, Velipasaoglu, Sahin, Uzun Basust, Midik, Coskun, Budakoglu, Mamakli, Tengiz, Durak, Ozan / A De Novo Tool... that the instruments were often tailored to a specific Scale (CLCS) (Demiral Yilmaz, 2010; Wangsaturak setting of interest (Schönrock-Adema, Bouwkamp- & McAleer, 2008), the Manchester Clinical Timmer, van Hell, & Cohen-Schotanus, 2012). Placement Index (MCPI) (Dornan et al., 2011), and As shown in Figure 1, recent scales have accessed the Undergraduate Clinical Education Environment the overall learning climate, the individual clinical Measure (UCEEM) (Strand et al., 2013). However, phase, or certain themes that can influence the no scales specifically measure the preclinical learning learning climate. The scales that have accessed climate in undergraduate medical education. the overall learning climate include the Medical It is impossible to conduct clinical studies without Student Education Environment Measure (MSLES) performing preclinical studies in undergraduate (Marshall, 1978); the scale developed by Polali and medical education. The basic difference between Price (2000); the Medical Education Environment the two learning climates is the transition from the Measure (MEEM) (Roff, McAleer, Harden, & Al- preclinical phase to the clinical phase. Although the Qahtani, 1996); and the Dundee Ready Education main objectives in the preclinical phase are to foster Environment Measure (DREEM) (Roff, 2005; Roff learning through small or large group activities and et al., 1996; Roff et al., 1997). The MSLES was the provide assessments of the students’ competency, first measurement tool used to evaluate the learning the overall objective in the clinical phase is to learn climate among medical students. The DREEM, by participating in daily practices (Dornan et al., another widely used scale to assess undergraduate 2011; Riley, 2009). medical education, distinguishes the learning environment in traditional medical schools from To date, in order to ensure vertical and horizontal the learning environment in innovative medical integration, medical training programs have schools and measures both clinical and preclinical undergone several changes. More specifically, phases in a program (Dornan et al., 2011; Soamentri the preclinical period currently includes learning et al., 2010). This tool was previously employed in a activities such as early clinical contact, simulation study on medical students in Turkey (Demirören, practice, and skills labs, while the clinical period Palaoglu, Kemahli, Özyurda, & Ayhan, 2008). consists of basic medical science courses in Furthermore, some scales are specific to clinical addition to the clinical applications (Cate, 2007; education such as the Clinical Learning Climate Harden & Davis, 1995; McClean, 2004). Despite Figure 1: Scales used to assess the learning climate in medical education programs. 1505 Educational Sciences: Theory & Practice these efforts, the preclinical period continues Literature Review and Generation of the Item to bear its distinctive features. These differences Pool: In Stage 1, a literature review was performed between the two phases can change the learning by the research team. In addition, the feedback climate and affect the students. During the clinical collected from the participating students in the stage, which is known to be a major source of stress preclinical phase was taken into account. The for students (Dahlin & Runeson, 2007; Sandars, students’ feedback focused on various aspects such as Patel, Steele, & Mcareavey, 2014), the students their opinions